AB0873 Ethnicity and patient reported outcome BASDAI in the monitoring of axial spondyloarthropathy: Does it matter?
Authors: S. Byravan, S. Jothimurugan, A. Moorthy
Journal: Annals of the Rheumatic Diseases (2022)

Background The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) is a patient reported outcome (PRO) used in the monitoring of axial spondyloarthropathy (axSpA). It is completed by the patient and based on their assessment of disease severity and therefore quite a subjective measure of disease (1). There has been research around the relationship between ethnicity and patient perception in Rheumatology. Many studies have demonstrated that non-Caucasian patients especially South Asians are less likely to engage with patient education, abandon their disease modifying therapy early and have more mistrust with the medical establishment (2). Quite a large population study in America examining axSpA severity in Caucasians, Afro-Caribbean’s and Latinos found Afro-Caribbean and Latino patients to score themselves higher on BASDAI compared to Caucasians (3). With Leicester being such a diverse area, with a particularly high South Asian population we took this opportunity to investigate whether there were ethnic variations in disease severity. Objectives The aim was to investigate whether there is a relationship between patient-reported outcome BASDAI and ethnicity. The secondary aim was to investigate the relationship between ethnicity and radiographic findings and extra-articular manifestations. Methods Data was collected by retrospective analysis of axSpA patients attending University of Leicester (UHL) axSpA services. Inclusion criteria entailed a diagnosis of axSpA with a documented BASDAI within a year of MRI spine + sacroiliac joints, prior to starting any biological treatment. Data of 149 patients was collected on demographic characteristics, extra-articular manifestations (uveitis, inflammatory back pain, enthesitis, peripheral arthritis, dactylitis, psoriasis, and inflammatory bowel disease), family history, response to NSAIDs, and HLA-B27 status. Data was analysed using Statistical Package for the Social Sciences (SPSS) software to assess the relationship between ethnicity and collected data using Pearson’s chi squared. Results Of the 149 patients 68% were White Caucasian, 30% Asian and 1% Black. The average age was 43 and 66% were male and 34% female. The mean BASDAI was 6.5, there was no observable correlation between BASDAI and ethnicity (p=0.668). There was no significant relationship between ethnicity and active sacroiliitis (p=0.926), chronic sacroiliitis (p= 0.218) or axial disease (p=0.307). 64 Caucasian patients were HLA-B27 positive compared with 27 Asian and no Black patients were positive however there was no statistical correlation between ethnicity and HLA-B27 (p=0.383). Overall, Caucasians consistently had a greater incidence of extra-articular manifestations compared with non-Caucasians however no significant p values were observed here or with response to NSAIDs, family history or familial HLA-B27 and BASDAI scores, results are summarised in Table 1. Table 1. Correlation with ethnicity and extra-articular manifestations, family history and HLA-B27. Number of patients Correlation with ethnicity Uveitis 36 p=0.470 Peripheral arthritis 24 p=0.304 Enthesitis 22 p=0.959 Psoriasis 7 p=0.062 Inflammatory bowel disease 7 P=0.947 Dactylitis 6 P=0.173 HLA-B27 103 p=0.383 Inflammatory back pain 139 p=0.062 Response to NSAIDs 46 p=0.718 Family history of axSpA 20 p=0.800 HLA-B27 in family 10 p=0.221 HLA-B27= Human leukocyte antigen B27, NSAIDs= non-steroidal anti-inflammatory drugs, axSpA= Axial Spondyloarthropathy. Conclusion This study did not demonstrate statistically significant finding of ethnic variations in BASDAI. There was also no relationship between ethnicity and other data sets. However, the main limitation of this study is the sample size and unequal representation of ethnicities with there being far more Caucasians than non-Caucasian patients. Though this study provides an insight into quite a limited area of research, a larger study with equal ethnic patient population samples is required to obtain more meaningful results. References [1]Zochling J. Measures of symptoms and disease status in ankylosing spondylitis: Ankylosing Spondylitis Disease Activity Score (ASDAS), Ankylosing Spondylitis Quality of Life Scale (ASQoL), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Global Score (BAS-G), Bath Ankylosing Spondylitis Metrology Index (BASMI), Dougados Functional Index (DFI), and Health Assessment Questionnaire for the Spondylarthropathies (HAQ-S). Arthritis Care Res (Hoboken). 2011;63(11):47-58. [2]Kumar K, Klocke R. Ethnicity in rheumatic disease. Clin Med (Lond). 2010;10(4):370-372. [3]Jamalyaria F, Ward M, Assassi S, Learch T, Lee M. Gensler L et al. Ethnicity and disease severity in ankylosing spondylitis a cross-sectional analysis of three ethnic groups. Clin Rheumatol. 2017;36(10):2359-2364. Disclosure of Interests None declared